A recently published study of a 2012 enterovirus outbreak that killed at least 54 Cambodian children has found that flare-ups of the virus tend to occur in a cyclical pattern, and that another one could be in store soon.

Widespread in the Asia-Pacific region, the virus is responsible for hand, foot and mouth disease among children, and is not necessarily fatal.

However, the strain identified as the culprit in the deaths in Cambodia in 2012, “EV71”, adversely affects the brain, heart and lungs, killing a high number of victims in a relatively short time frame.

Released last Wednesday ahead of its January publication in the US Centers for Disease Control and Prevention’s Journal of Emerging Infectious Diseases, Seroepidemiology of Human Enterovirus 71 Infection among Children, Cambodia draws upon analysis of children’s blood samples collected from 2000-2011 to see how prevalent the virus was prior to 2012.

The study’s authors concluded that “outbreaks occurred in a cyclical pattern in Cambodia”, infecting “large proportions” of non-immune children “every 2-3 years”.

Describing the potential for another outbreak, the report’s lead author and deputy head of the virology unit at the Institut Pasteur in Cambodia, Dr Paul Horwood, said in an email that “it is impossible to predict exactly when we will have another EV71 outbreak, but it is likely to happen in the next 1-2 years”, and that the data agree with observations of outbreaks in other countries in the region.

While the study’s “data support the widespread circulation of EV71 at least a decade before its reported emergence in 2012”, surveillance systems for EV71 have improved since then.

According to Horwood, “there is greater awareness among clinicians and the health community about EV71 disease. Institut Pasteur du Cambodge is also working closely with partners such as the Ministry of Health, Kantha Bopha [Children’s] hospitals and the World Health Organization to monitor for EV71 disease.”

Dr Ly Sovann, director of the Ministry of Health’s communicable disease control department, said in an email that in the past year, “only sporadic cases” of EV71 have been reported, and that the best ways to control the disease are “education, early detection and early response, [and the] development of vaccine to vaccinate the children”.

In February of last year, three laboratories in China published positive results for EV71 vaccines undergoing clinical trials.

Those in contact with a child who has been infected are advised to “frequently wash hand[s] with water and soap, separate the patient [from] other healthy [individuals]” and remove toys the child may have come into contact with in order to mitigate the spread, Sovann said.